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The Result of GOP Failure
Pre-existing conditions without an individual mandate was a time bomb.
PHOTO: GETTY IMAGES
By
Holman W. Jenkins, Jr.
July 18, 2017 6:41 p.m. ET
94 COMMENTS
It’s no excuse for Republican ineptitude, but there is little market in America, and none in the GOP apparently, for coherent health-care policy, to the modest degree that such a description can even apply in Washington.
Republicans, and arguably American voters, don’t want an individual mandate. They do want coverage of pre-existing conditions.
There is a term for a system in which you are covered if you are sick, but you don’t need to buy coverage and the government promises to make it affordable. It’s health care on demand, with taxpayers footing the bill. It’s single-payer—at least for the sizable portion of the population who can’t be induced through a giant tax incentive to accept insurance from their employer, or who aren’t already under some version of proto-single-payer such as Medicare, Medicaid, etc.
Obama Care was a dog’s breakfast, but at least it was coherent on this fundamental point.
Here’s how health care would sooner or later (most likely sooner) come to work in a system in which pre-existing conditions are covered but there is no individual mandate, as the GOP bill proposed.
You develop a symptom. You show up at the doctor and, in addition to the other forms, you fill out a form applying for insurance, which you cancel as soon as your treatment is complete.
If this is insurance, the cost is identical to the cost of treatment, which for some reason your insurance company fingers briefly (and takes a cut) before passing along to your doctor.
This is not insurance. Nor is it a viable business model for insurance companies, except as a receptor into which to pour taxpayer money to cover the cost of everyone’s health care. Now it can be told: The GOP plan that almost certainly now is dead would have been more of an express route to single-payer than ObamaCare ever was.
Republicans, though inconvenienced by John McCain’s keyhole craniotomy, could have passed something. It would have made no sense, except for the highly useful GOP curbs on Medicaid—which were worth the price of admission.
Every administration passes a health-care bill, knowing it won’t be the last word, certain in the knowledge they haven’t fixed anything fundamental in American health care. Reagan gave us Cobra to allow certain employees to keep their insurance after leaving their jobs. Clinton failed to give us HillaryCare but gave us the Children’s Health Insurance Program. George W. Bush gave us the Medicare drug entitlement. Obama gave us you-know-what. Only George H.W. Bush failed to enact the obligatory expansion of health-care entitlements for somebody somewhere. He was a one-term president.
Were a rational, coherent health-insurance law the apple of any eye, were legislators interested in serving up to the American people a system that would actually be viable and stable, what would it look like?
It would repeal and replace everything that isn’t ObamaCare. The bill would have 19 words: “All government programs and health care-related tax benefits are null and void, except for the Affordable Care Act.”
Then would come the much more tractable and cognizable job of fixing ObamaCare. The rational brain could actually get itself around it.
Which old people cast adrift from Medicare should receive ObamaCare subsidies, and how much? And how should incentives be structured so young and middle-aged people, via ObamaCare, start financing their own old-age health consumption?
How should pre-existing conditions be financed? By rolling the cost into everybody’s premiums, or by a separate taxpayer subsidy so individual premiums could be more actuarially based and attractive to most users?
Pre-existing conditions inevitably become a mere transitional problem when the individual mandate is fully institutionalized.
We could go on. Correcting the distortions and cross-subsidies that make ObamaCare such a morass, a death spiral in waiting, is not actually a hard job. A properly fixed ObamaCare would be the only health-care program Americans need.
This won’t happen, of course. Neither will single-payer. America’s jumble of health-care programs will just be increasingly poorly financed, with longer waits and fewer available providers. The rich, and those with good jobs in corporate America, will benefit from concierge health care in which all the frills and finery are available at a price. It will be expensive. But it will be a hell of lot better than Medicaid.
In the meantime, the Trump administration is becoming incalculable. Will it survive? In 16 months, after disastrous GOP midterms, will Mr. Trump announce he’s now a Democraticpresident? In return for what does Chuck Schumer throw him a lifeline? The people who put him in office would applaud and say that’s our Trump, even if the media would be completely nonplused.
Appeared in the July 19, 2017, print edition.
The Result of GOP Failure
Pre-existing conditions without an individual mandate was a time bomb.
PHOTO: GETTY IMAGES
By
Holman W. Jenkins, Jr.
July 18, 2017 6:41 p.m. ET
94 COMMENTS
It’s no excuse for Republican ineptitude, but there is little market in America, and none in the GOP apparently, for coherent health-care policy, to the modest degree that such a description can even apply in Washington.
Republicans, and arguably American voters, don’t want an individual mandate. They do want coverage of pre-existing conditions.
There is a term for a system in which you are covered if you are sick, but you don’t need to buy coverage and the government promises to make it affordable. It’s health care on demand, with taxpayers footing the bill. It’s single-payer—at least for the sizable portion of the population who can’t be induced through a giant tax incentive to accept insurance from their employer, or who aren’t already under some version of proto-single-payer such as Medicare, Medicaid, etc.
Obama Care was a dog’s breakfast, but at least it was coherent on this fundamental point.
Here’s how health care would sooner or later (most likely sooner) come to work in a system in which pre-existing conditions are covered but there is no individual mandate, as the GOP bill proposed.
You develop a symptom. You show up at the doctor and, in addition to the other forms, you fill out a form applying for insurance, which you cancel as soon as your treatment is complete.
If this is insurance, the cost is identical to the cost of treatment, which for some reason your insurance company fingers briefly (and takes a cut) before passing along to your doctor.
This is not insurance. Nor is it a viable business model for insurance companies, except as a receptor into which to pour taxpayer money to cover the cost of everyone’s health care. Now it can be told: The GOP plan that almost certainly now is dead would have been more of an express route to single-payer than ObamaCare ever was.
Republicans, though inconvenienced by John McCain’s keyhole craniotomy, could have passed something. It would have made no sense, except for the highly useful GOP curbs on Medicaid—which were worth the price of admission.
Every administration passes a health-care bill, knowing it won’t be the last word, certain in the knowledge they haven’t fixed anything fundamental in American health care. Reagan gave us Cobra to allow certain employees to keep their insurance after leaving their jobs. Clinton failed to give us HillaryCare but gave us the Children’s Health Insurance Program. George W. Bush gave us the Medicare drug entitlement. Obama gave us you-know-what. Only George H.W. Bush failed to enact the obligatory expansion of health-care entitlements for somebody somewhere. He was a one-term president.
Were a rational, coherent health-insurance law the apple of any eye, were legislators interested in serving up to the American people a system that would actually be viable and stable, what would it look like?
It would repeal and replace everything that isn’t ObamaCare. The bill would have 19 words: “All government programs and health care-related tax benefits are null and void, except for the Affordable Care Act.”
Then would come the much more tractable and cognizable job of fixing ObamaCare. The rational brain could actually get itself around it.
Which old people cast adrift from Medicare should receive ObamaCare subsidies, and how much? And how should incentives be structured so young and middle-aged people, via ObamaCare, start financing their own old-age health consumption?
How should pre-existing conditions be financed? By rolling the cost into everybody’s premiums, or by a separate taxpayer subsidy so individual premiums could be more actuarially based and attractive to most users?
Pre-existing conditions inevitably become a mere transitional problem when the individual mandate is fully institutionalized.
We could go on. Correcting the distortions and cross-subsidies that make ObamaCare such a morass, a death spiral in waiting, is not actually a hard job. A properly fixed ObamaCare would be the only health-care program Americans need.
This won’t happen, of course. Neither will single-payer. America’s jumble of health-care programs will just be increasingly poorly financed, with longer waits and fewer available providers. The rich, and those with good jobs in corporate America, will benefit from concierge health care in which all the frills and finery are available at a price. It will be expensive. But it will be a hell of lot better than Medicaid.
In the meantime, the Trump administration is becoming incalculable. Will it survive? In 16 months, after disastrous GOP midterms, will Mr. Trump announce he’s now a Democraticpresident? In return for what does Chuck Schumer throw him a lifeline? The people who put him in office would applaud and say that’s our Trump, even if the media would be completely nonplused.
Appeared in the July 19, 2017, print edition.
